=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861730988
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE MESIKU ABUCHA DNP, ACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2013
-----------------------------------------------------
Last Update Date | 09/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12851 W BELL RD STE 126
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-9610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-399-9645
-----------------------------------------------------
Fax | 866-355-0977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12851 W BELL RD STE 126
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-9610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-399-9645
-----------------------------------------------------
Fax | 866-355-0977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | AP4804
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------